Smoking Cessation

Question 1

List the 5 A approach to smoking cessation

Answer 1

Ask if patient smokes
Advise Patient to quit
Assess willingness to quit (stages of change)
Assist in quit attempt
Arrange for follow up

Question 2

What / How often do you Ask if the patient smokes?

Answer 2

Ask EVERYONE whenever you can

Ask if they’ve smoked within the last 6 months

Question 3

What are 3 considerations in your messaging when advising a patient to quit smoking?

Answer 3

Advice must be CLEAR, STRONG, PERSONALIZED

Question 4

What are the 5 R’s when Assessing a patient’s willingness to quit?

Answer 4

Relevance to the patient
Risks of smoking
Rewards of quitting
Roadblocks to quitting
Repetition q 6 – 12 mo

Question 5

List 5 risks of smoking

Answer 5

Cancer
Heart Disease
Stroke
COPD
Complications in pregnancy
Second Hand Smoke

Question 6

List 5 rewards to quitting tobacco smoke

Answer 6

Leading cause of preventable death
Financial gains (1ppy = $3650 per year)
Reduce risks of erectile dysfunction
8h - Carbon monoxide eliminated
24h - Risk of heart attack begins to drop
2w - Improved in lung function, walking easier
1mo - Decreased coughing, nasal congestion, shortness of breath
1y - Risk of coronary heart disease halved
5y - Risk of stroke same level as non-smokers
10y - Risk of mouth, throat and esophageal cancer halved, death rate from lung cancer also halved
15y - Risk of heart attacks similar to that of non-smokers

Question 7

List 5 elements of tobacco smoking history

Answer 7

Treatment preferences
Smoking History
Quitting History
Current meds
Contraindications
Pregnancy
Mental Illness
Substance Use Disorder

Question 8

Describe the STAR method of Assisting Tobacco smoke cessation

Answer 8

Set a quit date within 2 weeks - 30 days. Total abstinence is better than reduction.

Tell friends and family, co-workers, request support.

Anticipate challenges that patient will face. Advised withdraw symptoms. Discuss triggers. Highest relapse within 3 mo of quitting.

Remove all tobacco products, recommend counselling programs and medications.

Question 9

List 3 first line pharmacotherapy treatments

Answer 9

Varenicline (Champix)
Bupropion (Zyban)
Nicotine Replacement Therapy (NRT)

Question 10

Varenicline: How long before quit date do you start? How long is treatment usually? List S/E, what conditions must you take caution with?

Answer 10

Start med 1 week before quit date
12-week course
Caution in renal failure, depression, suicide
ADR: insomnia, nausea, abnormal dreams

Question 11

Bupropion: How long before quit date do you start? List S/E. What are contraindications?

Answer 11

Begin 1 w before quit date and 150 mg / d, then 150 mg BID
C/i: seizure disorder, eating disorder, MOA inhibitor
ADR: insomnia, headache, dizzy, xerostomia, increased BP

Question 12

List 3 types of nicotine replacement therapies. With what conditions must caution be taken?

Answer 12

Patch, Gum / Lozenge, Inhaler

Caution in CVD , post MI.

Question 13

List 2 second line treatments

Answer 13

Clonidine

Nortriptyline

Question 14

How long before quit date do you start clonidine? What are S/E?

Answer 14

Start 3 d prior to quit

S/E: dry mouth, dizziness, sedation, constipation, decreased BP

Question 15

How long before quit date do you start Nortriptyline? What are S/E?

Answer 15

Start 1028 d prior to quit date

sedative, dry mouth, blurred vision, retention

Question 16

Describe a non pharmacologic treatment. How many, how long?

Answer 16

Brief Intervention / Telephone counselling:
4+ counselling sessions > 10 min
6 -12 mo follow up.

Question 17

Treatment for pregnancy

Answer 17

Encourage to quit without meds

Intermittent nicotine instead of patches if necessary

Question 18

Treatment with concurrent / hx of depression

Answer 18

Bupropion, Nortriptyline

Question 19

Treatment with wt gain

Answer 19

Bupropion, 4 mg gum + lozenges

Question 20

Treatment for pt with CVD

Answer 20

Still use NRT - patch is safe